Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 677
Filtrar
1.
Medicine (Baltimore) ; 100(5): e24409, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592888

RESUMO

ABSTRACT: Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).


Assuntos
Doenças do Sistema Digestório , Procedimentos Cirúrgicos do Sistema Digestório , Tratamento de Emergência , Controle de Infecções , Complicações Pós-Operatórias , Tempo para o Tratamento , Adulto , /prevenção & controle , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/epidemiologia , Doenças do Sistema Digestório/mortalidade , Doenças do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Emergências/epidemiologia , Tratamento de Emergência/efeitos adversos , Tratamento de Emergência/métodos , Tratamento de Emergência/mortalidade , Feminino , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Masculino , Mortalidade , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Projetos de Pesquisa , Medição de Risco/métodos
2.
Emerg Infect Dis ; 27(2): 669-672, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33496649

RESUMO

Despite mitigation efforts, 2 coronavirus disease outbreaks were identified among office workers in Washington, DC. Moderate adherence to workplace mitigation efforts was reported in a serologic survey; activities outside of the workplace were associated with infection. Adherence to safety measures are critical for returning to work during the pandemic.


Assuntos
/estatística & dados numéricos , Surtos de Doenças/prevenção & controle , Controle de Infecções/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Adulto , Anticorpos Antivirais/sangue , /diagnóstico , District of Columbia/epidemiologia , Feminino , Implementação de Plano de Saúde , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos
3.
AANA J ; 89(1): 71-75, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33501911

RESUMO

The ongoing coronavirus disease 2019 (COVID-19) pandemic has created many changes and difficulties in healthcare, and the anesthesia specialty is no exception. Both the increased need for personal protective equipment (PPE) and the potential for infection and contamination through respiratory droplets have been sources of much concern. Policies and protocols have been adapted worldwide to help neutralize infection risk and exposure. Transmission of the virus to healthcare workers has been a major concern, and the risk of infection is exceptionally high for Certified Registered Nurse Anesthetists (CRNAs) because of their close contact with infected patients. CRNAs are in a unique position to help decrease exposure for themselves and other members of the healthcare team by taking extra precautions during airway manipulation. A great deal of focus has been placed on reducing risks during intubation, but reports describing methods of reducing contamination and exposure to respiratory droplets during emergence and extubation are scarce. The authors have reviewed techniques to reduce coughing, thereby decreasing the potential of virus exposure through contact with large respiratory droplets and aerosolized particles that may remain suspended in air.


Assuntos
/prevenção & controle , Pessoal de Saúde/psicologia , Controle de Infecções/métodos , Controle de Infecções/normas , Salas Cirúrgicas/normas , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Atitude do Pessoal de Saúde , Guias como Assunto , Humanos , Controle de Infecções/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos
4.
Res Social Adm Pharm ; 17(1): 1845-1852, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33317763

RESUMO

Pharmacies have been practicing innovative infection control measures during COVID-19. This article seeks to explore the current activities undertaken across various community pharmacy settings in relation to the safety of the workplace environment for staff and patients. METHODS: An online cross-sectional survey was conducted in Australia during the COVID-19 outbreak from 1st to 30th April 2020, addressing community pharmacist's awareness and response to infection and sanitation control. RESULTS: A total of 137 pharmacists took part in the survey. Regular cleaning took place in the pharmacy, but the use of gloves while cleaning was not regularly practice (48.18%). In addition, only 46.72% of respondents reported observing script baskets being cleaned and disinfected. About one-third (37.96%) of pharmacists were aware of the two-step cleaning and disinfecting process, with only 18.98% of pharmacist practicing such cleaning procedures. More than half of surveyed pharmacists reported having difficulty keeping up with pharmacy practice and infection control guidelines during the pandemic. CONCLUSION: This study demonstrates that the majority of pharmacists are not fully aware of the proper infection control measures needed in a community pharmacy setting. Pharmacists must play a bigger role in infection control measures to ensure staff and public health safety.


Assuntos
/prevenção & controle , Serviços Comunitários de Farmácia/organização & administração , Controle de Infecções/métodos , Farmacêuticos/organização & administração , Adolescente , Adulto , Idoso , Austrália , Estudos Transversais , Desinfecção/métodos , Feminino , Humanos , Controle de Infecções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/estatística & dados numéricos , Papel Profissional , Inquéritos e Questionários , Adulto Jovem
5.
PLoS One ; 15(12): e0242961, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351819

RESUMO

Presurgical hand asepsis is part of the daily routine in veterinary medicine. Nevertheless, basic knowledge seems to be low, even among specialised veterinary surgeons. The major objectives of our study were to assess current habits for presurgical hand preparation (phase 1) among personnel in a veterinary hospital and their effectiveness in reducing bacteria from hands in comparison to a standardised protocol (phase 2). Assessment of individual habits focused on time for hand washing and disinfection, the amount of disinfectant used, and the usage of brushes. The standardised protocol defined hand washing for 1 min with liquid neutral soap without brushing and disinfection for 3 min. All participants (2 surgeons, 8 clinic members, 32 students) used Sterillium®. Total bacterial counts were determined before and after hand washing, after disinfection, and after surgery. Hands were immersed in 100 ml sterile sampling fluid for 1 min and samples were inoculated onto Columbia sheep blood agar using the spread-plate method. Bacterial colonies were manually counted. Glove perforation test was carried out at the end of the surgical procedure. Differences in the reduction of relative bacterial numbers between current habits and the standardised protocol were investigated using Mann-Whitney-Test. The relative increase in bacterial numbers as a function of operation time (≤60 min, >60 min) and glove perforation as well as the interaction of both was investigated by using ANOVA. Forty-six and 41 preparations were carried out during phase 1 and phase 2, respectively. Individual habits differed distinctly with regard to time (up to 8 min) and amount of disinfectant (up to 48 ml) used both between participants and between various applications of a respective participant. Comparison of current habits and the standardised protocol revealed that the duration of hand washing had no significant effect on reducing bacteria. Contrary, the reduction in bacterial numbers after disinfection by the standardised protocol was significantly higher (p<0.001) compared to routine every-day practice. With regard to disinfection efficacy, the standardised protocol completely eliminated individual effects. The mean reduction in phase 1 was 90.72% (LR = 3.23; right hand) and 89.97% (LR = 3.28; left hand) compared to 98.85% (LR = 3.29; right hand) and 98.92% (LR = 3.47; left hand) in phase 2. Eight participants (19%) carried MRSA (spa type t011, CC398) which is well established as a nosocomial pathogen in veterinary clinics. The isolates could further be assigned to a subpopulation which is particularly associated with equine clinics (mainly t011, ST398, gentamicin-resistant). Glove perforation occurred in 54% (surgeons) and 17% (assistants) of gloves, respectively, with a higher number in long-term invasive procedures. Overall, bacterial numbers on hands mainly increased over time, especially when glove perforation occurred. This was most distinct for glove perforations on the left hand and with longer operating times. Our results demonstrate that standardised protocols highly improve the efficacy of hand asepsis measures. Hence, guiding standardised protocols should be prerequisite to ensure state-of-the-art techniques which is essential for a successful infection control intervention.


Assuntos
Mãos , Cavalos , Hospitais Veterinários/normas , Controle de Infecções/normas , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Animais , Luvas Cirúrgicas , Desinfecção das Mãos/normas , Humanos , Controle de Infecções/estatística & dados numéricos , Padrões de Referência
6.
Front Public Health ; 8: 590275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33330335

RESUMO

The COVID-19 pandemic has laid bare the inadequacy of the U.S. healthcare system to deliver timely and resilient care. According to the American Hospital Association, the pandemic has created a $202 billion loss across the healthcare industry, forcing health care systems to lay off workers and making hospitals scramble to minimize supply chain costs. However, as the demand for personal protective equipment (PPE) grows, hospitals have sacrificed sustainable solutions for disposable options that, although convenient, will exacerbate supply strains, financial burden, and waste. We advocate for reusable gowns as a means to lower health care costs, address climate change, and improve resilience while preserving the safety of health care workers. Reusable gowns' polyester material provides comparable capacity to reduce microbial cross-transmission and liquid penetration. In addition, previous hospitals have reported a 50% cost reduction in gown expenditures after adopting reusable gowns; given the current 2000% price increase in isolation gowns during COVID-19, reusable gown use will build both healthcare resilience and security from price fluctuations. Finally, with the United States' medical waste stream worsening, reusable isolation gowns show promising reductions in energy and water use, solid waste, and carbon footprint. The gowns are shown to withstand laundering 75-100 times in contrast to the single-use disposable gown. The circumstances of the pandemic forewarn the need to shift our single-use PPE practices to standardized reusable applications. Ultimately, sustainable forms of protective equipment can help us prepare for future crises that challenge the resilience of the healthcare system.


Assuntos
/prevenção & controle , Equipamentos Descartáveis/economia , Reutilização de Equipamento/economia , Pessoal de Saúde/estatística & dados numéricos , Controle de Infecções/economia , Pandemias/prevenção & controle , Roupa de Proteção/economia , Adulto , Equipamentos Descartáveis/estatística & dados numéricos , Reutilização de Equipamento/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/economia , Exposição Ocupacional/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Roupa de Proteção/estatística & dados numéricos , Estados Unidos
8.
J Glob Health ; 10(2): 020507, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33110590

RESUMO

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study registration: Registered in ClinicalTrials.gov: NCT04344197.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/normas , Betacoronavirus , Infecções por Coronavirus/transmissão , Infecção Hospitalar/virologia , Estudos Transversais , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Programas de Rastreamento/normas , Pneumonia Viral/transmissão , Políticas , Padrões de Prática Médica/normas , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Inquéritos e Questionários
9.
J Psychiatr Res ; 131: 244-254, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33035957

RESUMO

BACKGROUND: COVID-19 has affected social interaction and healthcare worldwide. METHODS: We examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths. We conducted interrupted time series analyses with respect to the time of UK "lockdown", which was shortly before the peak of COVID-19 infections in this area. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI). RESULTS: Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity. CONCLUSIONS: COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. "Supply" changes may have reduced access to mental health services for some. "Demand" changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Infecções por Coronavirus , Acesso aos Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais/mortalidade , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Controle de Infecções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mortalidade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Reino Unido/epidemiologia , Adulto Jovem
10.
Nat Hum Behav ; 4(10): 1080-1090, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33024280

RESUMO

Starting in mid-May 2020, many US states began relaxing social-distancing measures that were put in place to mitigate the spread of COVID-19. To evaluate the impact of relaxation of restrictions on COVID-19 dynamics and control, we developed a transmission dynamic model and calibrated it to US state-level COVID-19 cases and deaths. We used this model to evaluate the impact of social distancing, testing and contact tracing on the COVID-19 epidemic in each state. As of 22 July 2020, we found that only three states were on track to curtail their epidemic curve. Thirty-nine states and the District of Columbia may have to double their testing and/or tracing rates and/or rolling back reopening by 25%, while eight states require an even greater measure of combined testing, tracing and distancing. Increased testing and contact-tracing capacity is paramount for mitigating the recent large-scale increases in US cases and deaths.


Assuntos
Busca de Comunicante/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/estatística & dados numéricos , Modelos Teóricos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Isolamento Social , Humanos , Estados Unidos
12.
PLoS One ; 15(10): e0239744, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057417

RESUMO

BACKGROUND: Globally, health care-associated infections had become serious public health importance. Compliance with standard safety precaution is effective and inexpensive measure to improve quality of healthcare in reducing occurrence of healthcare associated infections. In developing countries, like Ethiopia adherence to recommended standard safety precaution is scanty. OBJECTIVE: To assess level of compliance with standard safety precaution and associated factors among healthcare workers in Hawassa comprehensive specialized hospital Southern Ethiopia. METHODS: An institutional based cross-sectional study was conducted at Hawassa comprehensive specialized hospital. Data were collected by using self-administered questionnaire. Study participants were allocated proportionally based on their profession by using stratified random sampling method. Data were entered and analyzed by using SPSS version 20.0. Bi-variable analysis and multi variable logistic regression model were used to check which variables were associated with dependent variable. P-values ≤ 0.05 were considered statistically significant. In this study the overall compliance with standard safety precaution among healthcare workers were only 56.5%. Being female healthcare worker AOR: 2.76(1.34, 5.54), married healthcare workers AOR: 4.2(2, 9.03), accessibility of safety box AOR: 3.4(1.6, 7.17), HCWs had perceived IP training AOR: 3.99(1.46, 10.9), availability of tape water AOR: 2.68(1.15, 6.2) and healthcare workers had internal infection prevention and control supportive supervision AOR: 5.8(2.54, 13.48) associated with compliance with standard safety precaution. CONCLUSION: According to findings of the current study, overall level of compliance with standard SP among HCWs considered to be very low. Factors such as healthcare workers being female, accessibility of safety box, availability of running tape water, training and supportive supervision were independent predictors of compliance with standard safety precaution. Thus ensuring availability and accessibility of safety precaution materials and regular observing and supervising healthcare workers' practices are highly recommended.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Universidades/estatística & dados numéricos , Adulto , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Etiópia , Feminino , Humanos , Controle de Infecções/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
13.
J Pediatr Orthop ; 40(10): e990-e993, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33045161

RESUMO

BACKGROUND: The COVID-19 pandemic has substantially altered the typical process around performing surgery to ensure protection of health care workers, patients, and their families. One safety precaution has been the implementation of universal preoperative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examines the results of universal screening on children undergoing orthopaedic surgery. METHODS: This is a retrospective cohort study evaluating the incidence and symptomatology of COVID-19 in all patients presenting for orthopaedic surgery at 3 pediatric tertiary care children's hospitals during the COVID-19 pandemic (March to June 2020). All patients underwent universal screening with a nasopharyngeal swab to detect presence of SARS-CoV-2. Bivariate and multivariate logistic regression analysis was performed to identify risk factors for positive COVID-19 screening. RESULTS: In total, 1198 patients underwent preoperative screening across all 3 institutions and 7 (0.58%) had detection of SARS-CoV-2. The majority of patients (1/7, 86%) were asymptomatic. Patients that tested positive were significantly more likely to be Hispanic (P=0.046) and had greater number of medical comorbidities (P=0.013), as scored on the American Society of Anesthesiologists (ASA) physical status score. A known COVID-19 positive contact was found to be a significant risk factor in the multivariate analysis (P=0.004). CONCLUSIONS: Early results of universal preoperative screening for COVID-19 demonstrates a low incidence and high rate of asymptomatic patients. Health care professionals, especially those at higher risk for the virus, should be aware of the challenges related to screening based solely on symptoms or travel history and consider universal screening for patients undergoing elective surgery. LEVEL OF EVIDENCE: Level II.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Programas de Triagem Diagnóstica , Controle de Infecções , Procedimentos Ortopédicos/métodos , Pandemias , Pneumonia Viral , Cuidados Pré-Operatórios/métodos , Criança , Técnicas de Laboratório Clínico/métodos , Busca de Comunicante , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Grupos Étnicos , Feminino , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Estudos Retrospectivos , Estados Unidos
15.
Arch Pediatr ; 27(8): 423-427, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33011025

RESUMO

BACKGROUND: The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. METHODS: We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pre-tested Google Form®. RESULTS: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%), of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (P<0.000). According to the occupancy rate of hospitalisation beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalisation beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (P<0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (P<0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). CONCLUSION: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus , Pandemias , Pediatras/psicologia , Pediatria/tendências , Pneumonia Viral , Padrões de Prática Médica/tendências , Adulto , Camarões , Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Relações Profissional-Família , Telemedicina
16.
Sci Rep ; 10(1): 18422, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33116179

RESUMO

We use an individual based model and national level epidemic simulations to estimate the medical costs of keeping the US economy open during COVID-19 pandemic under different counterfactual scenarios. We model an unmitigated scenario and 12 mitigation scenarios which differ in compliance behavior to social distancing strategies and in the duration of the stay-home order. Under each scenario we estimate the number of people who are likely to get infected and require medical attention, hospitalization, and ventilators. Given the per capita medical cost for each of these health states, we compute the total medical costs for each scenario and show the tradeoffs between deaths, costs, infections, compliance and the duration of stay-home order. We also consider the hospital bed capacity of each Hospital Referral Region (HRR) in the US to estimate the deficit in beds each HRR will likely encounter given the demand for hospital beds. We consider a case where HRRs share hospital beds among the neighboring HRRs during a surge in demand beyond the available beds and the impact it has in controlling additional deaths.


Assuntos
Infecções por Coronavirus/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Pandemias/economia , Pneumonia Viral/economia , Fortalecimento Institucional/economia , Fortalecimento Institucional/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Instalações de Saúde/economia , Instalações de Saúde/estatística & dados numéricos , Humanos , Controle de Infecções/economia , Controle de Infecções/estatística & dados numéricos , Modelos Estatísticos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estados Unidos
18.
S Afr Med J ; 110(8): 791-795, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880308

RESUMO

BACKGROUND: Intensive care unit (ICU)-related healthcare-associated infections (HCAIs) are two to three times higher in lower-income countries than in higher-income ones. Hand cleansing and other hygiene measures have been documented as one of the most effective measures in combating the transmission of HCAIs. There is a paucity of data pertaining to hygiene practices in the ICU in developing countries. OBJECTIVES: To determine compliance with hygiene practices among healthcare workers in a tertiary hospital ICU. METHODS: Hygiene practices of healthcare workers in a tertiary academic hospital ICU in Johannesburg, South Africa, were discreetly observed over an 8-week period. Compliance with hand cleansing and other hygiene practices was documented and analysed. Retrospective consent was obtained, and subject confidentiality was maintained. RESULTS: A total of 745 hygiene opportunities were observed. Of the 156 opportunities where handwashing with soap and water was indicated (20.9%), compliance was noted in 89 cases (57.1%), while an alcohol-based hand rub was inappropriately used in 34 cases (21.8%) and no hand hygiene was performed in the remaining 33 cases (21.1%). Of the 589 opportunities where an alcohol-based hand-rub was indicated, it was used in 312 cases (53.0%). Compliance with the donning of disposable surgical gloves, disposable plastic aprons and being 'bare below the elbows' was noted in 114 (90.6%), 108 (71.1%) and 355 (47.7%) opportunities, respectively, where these were indicated. CONCLUSIONS: Overall compliance with hygiene measures among healthcare workers in the ICU was suboptimal in this study, but in keeping with general international trends. Regular retraining of staff, frequent reminders, peer oversight and regular audits may improve compliance.


Assuntos
Desinfecção das Mãos , Higienizadores de Mão/administração & dosagem , Controle de Infecções/estatística & dados numéricos , Unidades de Terapia Intensiva , Recursos Humanos em Hospital , Roupa de Proteção/estatística & dados numéricos , Centros Médicos Acadêmicos , Auditoria Clínica , Estudos Transversais , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Controle de Infecções/normas , África do Sul , Centros de Atenção Terciária
19.
Sensors (Basel) ; 20(17)2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32887338

RESUMO

COVID-19 has shown a relatively low case fatality rate in young healthy individuals, with the majority of this group being asymptomatic or having mild symptoms. However, the severity of the disease among the elderly as well as in individuals with underlying health conditions has caused significant mortality rates worldwide. Understanding this variance amongst different sectors of society and modelling this will enable the different levels of risk to be determined to enable strategies to be applied to different groups. Long-established compartmental epidemiological models like SIR and SEIR do not account for the variability encountered in the severity of the SARS-CoV-2 disease across different population groups. The objective of this study is to investigate how a reduction in the exposure of vulnerable individuals to COVID-19 can minimise the number of deaths caused by the disease, using the UK as a case study. To overcome the limitation of long-established compartmental epidemiological models, it is proposed that a modified model, namely SEIR-v, through which the population is separated into two groups regarding their vulnerability to SARS-CoV-2 is applied. This enables the analysis of the spread of the epidemic when different contention measures are applied to different groups in society regarding their vulnerability to the disease. A Monte Carlo simulation (100,000 runs) along the proposed SEIR-v model is used to study the number of deaths which could be avoided as a function of the decrease in the exposure of vulnerable individuals to the disease. The results indicate a large number of deaths could be avoided by a slight realistic decrease in the exposure of vulnerable groups to the disease. The mean values across the simulations indicate 3681 and 7460 lives could be saved when such exposure is reduced by 10% and 20% respectively. From the encouraging results of the modelling a number of mechanisms are proposed to limit the exposure of vulnerable individuals to the disease. One option could be the provision of a wristband to vulnerable people and those without a smartphone and contact-tracing app, filling the gap created by systems relying on smartphone apps only. By combining very dense contact tracing data from smartphone apps and wristband signals with information about infection status and symptoms, vulnerable people can be protected and kept safer.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/estatística & dados numéricos , Modelos Teóricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Saúde Pública/métodos , Quarentena/organização & administração , Populações Vulneráveis , Busca de Comunicante/métodos , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/prevenção & controle , Diretrizes para o Planejamento em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Controle de Infecções/estatística & dados numéricos , Invenções/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/normas , Saúde Pública/estatística & dados numéricos , Administração em Saúde Pública/métodos , Quarentena/métodos , Quarentena/estatística & dados numéricos , Reino Unido/epidemiologia , Populações Vulneráveis/estatística & dados numéricos
20.
Math Biosci Eng ; 17(4): 4165-4183, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32987574

RESUMO

In this paper we develop a compartmental epidemic model to study the transmission dynamics of the COVID-19 epidemic outbreak, with Mexico as a practical example. In particular, we evaluate the theoretical impact of plausible control interventions such as home quarantine, social distancing, cautious behavior and other self-imposed measures. We also investigate the impact of environmental cleaning and disinfection, and government-imposed isolation of infected individuals. We use a Bayesian approach and officially published data to estimate some of the model parameters, including the basic reproduction number. Our findings suggest that social distancing and quarantine are the winning strategies to reduce the impact of the outbreak. Environmental cleaning can also be relevant, but its cost and effort required to bring the maximum of the outbreak under control indicate that its cost-efficacy is low.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Modelos Biológicos , Pandemias , Pneumonia Viral/transmissão , Número Básico de Reprodução/estatística & dados numéricos , Teorema de Bayes , Simulação por Computador , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Desinfecção/estatística & dados numéricos , Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Conceitos Matemáticos , México/epidemiologia , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Isolamento de Pacientes/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena/estatística & dados numéricos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...